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Lee SK, Serhal AM, Serhal M, Michalek J, Omar IM. The role of high-resolution ultrasound and MRI in the evaluation of peripheral nerves in the lower extremity. J Ultrason 2023; 23:e328-e346. [PMID: 38020505 PMCID: PMC10668932 DOI: 10.15557/jou.2023.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/22/2023] [Indexed: 12/01/2023] Open
Abstract
Lower extremity peripheral neuropathy is a commonly encountered neurologic disorder, which can lead to chronic pain, functional disability, and decreased quality of life for a patient. As diagnostic imaging modalities have improved, imaging has started to play an integral role in the detection and characterization of peripheral nerve abnormalities by non-invasively and accurately identifying abnormal nerves as well as potential causes of neuropathy, which ultimately leads to precise and timely treatment. Ultrasound, which has high spatial resolution and can quickly and comfortably characterize peripheral nerves in real time along with associated denervation muscle atrophy, and magnetic resonance neurography, which provides excellent contrast resolution between nerves and other tissues and between pathologic and normal segments of peripheral nerves, in addition to assessing reversible and irreversible muscle denervation changes, are the two mainstay imaging modalities used in peripheral nerve assessment. These two modalities are complimentary, and one may be more useful than the other depending on the nerve and location of pathology. Imaging must be interpreted in the context of available clinical information and other diagnostic studies, such as electrodiagnostic tests. Here, we offer a comprehensive overview of the role of high-resolution ultrasound and magnetic resonance neurography in the evaluation of the peripheral nerves of the lower extremity and their associated neuropathies.
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Affiliation(s)
- Steven Kyungho Lee
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Ali Mostafa Serhal
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Muhamad Serhal
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Julia Michalek
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Imran Muhammad Omar
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
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Andrade Fernandes de Mello R, Garcia Rondina R, Valim V, Santos Belisario S, Burgomeister Lourenço R, Francisco Batista E, Horst Duque R. Isolated atrophy of the abductor digiti quinti in patients with rheumatoid arthritis. Skeletal Radiol 2017; 46:1715-1720. [PMID: 28799033 DOI: 10.1007/s00256-017-2741-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/11/2017] [Accepted: 07/24/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We aim to discuss the association of isolated atrophy of the abductor digiti quinti muscle in patients with rheumatoid arthritis as well as review the anatomy and imaging findings of this condition on MRI. MATERIALS AND METHODS A consecutive series of 55 patients diagnosed with rheumatoid arthritis according to the 2010 ACR/EULAR classification criteria were recruited. MRI of the clinically dominant feet was performed using a 1.5-T scanner. RESULTS The study population was predominantly female (94.5%), and the age range was 31-79 years (mean 57.5 ± 11). A total of 55 ankles were examined by MRI, and 20 patients (36.3%), all females, showed abductor digiti quinti denervation signs. Seven patients demonstrated severe fatty atrophy of the abductor digiti quinti, corresponding to Goutallier grade 4, 2 patients showed moderate fatty atrophy (Goutallier grade 3), and the remaining 11 patients showed less than 50% fatty atrophy, corresponding to a Goutallier grade 2. Substantial agreement was found for both intra- and interobserver agreement regarding the Goutallier grading system. CONCLUSION Prevalence of signs of abductor digiti quinti denervation on MRI was high in the studied population, suggesting that rheumatoid arthritis may be associated with inferior calcaneal nerve compression.
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Affiliation(s)
| | - Ronaldo Garcia Rondina
- Department of Internal Medicine, Universidade Federal do Espírito Santo, Av. Marechal Campos 1468, Vitória, ES, Brazil
| | - Valéria Valim
- Department of Internal Medicine, Universidade Federal do Espírito Santo, Av. Marechal Campos 1468, Vitória, ES, Brazil
| | - Stéphano Santos Belisario
- Department of Internal Medicine, Universidade Federal do Espírito Santo, Av. Marechal Campos 1468, Vitória, ES, Brazil
| | | | - Elton Francisco Batista
- Department of Internal Medicine, Universidade Federal do Espírito Santo, Av. Marechal Campos 1468, Vitória, ES, Brazil
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Marquez Neto OR, Leite MS, Freitas T, Mendelovitz P, Villela EA, Kessler IM. The role of magnetic resonance imaging in the evaluation of peripheral nerves following traumatic lesion: where do we stand? Acta Neurochir (Wien) 2017; 159:281-290. [PMID: 27999953 DOI: 10.1007/s00701-016-3055-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 12/12/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Peripheral nerve injury is a common and important cause of morbidity and disability in patients who have suffered a traumatic injury, particularly younger people. Various different injuries can result in damage to specific nerves. In patients with multiple trauma, the prevalence of peripheral nerve injury is estimated at 2.8%, but can reach 5% with the inclusion of brachial plexus involvement. Physical examination, as well as the origin and location of the trauma, can indicate the nerve involved and the type of nerve damage. However, the depth and severity of damage, and the structures involved often cannot be determined initially, but depend on longer periods of observation to reach a definitive and accurate diagnosis for which treatment can be proposed. Current approaches to locate and assess the severity of traumatic nerve injury involve clinical and electrodiagnostic studies. From a clinical and neurophysiological point of view, nerve injuries are classified in an attempt to correlate the degree of injury with symptoms, type of pathology, and prognosis, as well as to determine the therapy to be adopted. OBJECTIVES MRI in the diagnosis of traumatic peripheral nerve injury has increasingly been used by surgeons in clinical practice. In this article, we analyze the use of magnetic resonance (MR) for the evaluation of traumatic peripheral nerve diseases that are surgically treatable. We also consider basic concepts in the evaluation of technical and MR signs of peripheral nerve injuries. MATERIALS AND METHODS Studies were identified following a computerized search of MEDLINE (1950 to present), EMBASE (1980 to present), and the Cochrane database. The MEDLINE search was conducted on PUBMED, the EMBASE search was conducted on OVID, and the Cochrane database was conducted using their online library. A set was created using the terms: 'traumatic', 'nerve', and 'resonance'. RESULTS The included articles were identified using a computerized search and the resulting databases were then sorted according to the inclusion and exclusion criteria. This yielded 10,340 articles (MEDLINE, n = 758; EMBASE, n = 9564; and Cochrane, n = 18). A search strategy was then built by excluding articles that only concern plexus injury and adding the terms 'neuropathies', 'DTI' and 'neurotmesis'. In total, seven studies were included in the review effectively addressing the role of MRI in the evaluation of traumatic peripheral nerve injury. We extracted all relevant information on the imaging findings and the use of magnetic resonance in trauma. We did not include technical or specific radiological aspects of the imaging techniques. CONCLUSIONS These seven articles were subsequently evaluated by analyzing their results, methodological approach, and conclusions presented.
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Affiliation(s)
- Oswaldo Ribeiro Marquez Neto
- Department of Neurosurgery, University Hospital of Brasilia, UnB, Secretaria de Clínica Cirurgica SGAN 605, Av. L2 Norte, Brasilia, DF, CEP: 70.830200, Brazil.
| | - Matheus Silva Leite
- Department of Neurosurgery, Hospital de Base do Distrito Federal, SMHS - Área Especial- Q. 101, Brasília, DF, CEP :70330-150, Brazil
| | - Tiago Freitas
- Department of Neurosurgery, Hospital de Base do Distrito Federal, SMHS - Área Especial- Q. 101, Brasília, DF, CEP :70330-150, Brazil
| | - Paulo Mendelovitz
- Department of Radiology, University Hospital of Brasilia, UnB, Radiologia SGAN 605, Av. L2 Norte, Brasilia, DF, CEP: 70.830200, Brazil
| | - Eric Arruda Villela
- Department of Hand Surgery, Hospital de Base do Distrito Federal, SMHS - Área Especial- Q. 101, Brasília, DF, CEP :70330-150, Brazil
| | - Iruena Moraes Kessler
- Department of Neurosurgery, University Hospital of Brasilia, UnB, Secretaria de Clínica Cirurgica SGAN 605, Av. L2 Norte, Brasilia, DF, CEP: 70.830200, Brazil
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De Maeseneer M, Madani H, Lenchik L, Kalume Brigido M, Shahabpour M, Marcelis S, de Mey J, Scafoglieri A. Normal Anatomy and Compression Areas of Nerves of the Foot and Ankle: US and MR Imaging with Anatomic Correlation. Radiographics 2015; 35:1469-82. [PMID: 26284303 DOI: 10.1148/rg.2015150028] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The anatomy of the nerves of the foot and ankle is complex, and familiarity with the normal anatomy and course of these nerves as well as common anatomic variants is essential for correct identification at imaging. Ultrasonography (US) and magnetic resonance (MR) imaging allow visualization of these nerves and may facilitate diagnosis of various compression syndromes, such as "jogger's heel," Baxter neuropathy, and Morton neuroma. It may be difficult to distinguish the nerves from adjacent vasculature at MR imaging, and US can help in differentiation. The authors review the normal anatomy and common variants of the nerves of the foot and ankle, with use of dissected specimens and correlative US and MR imaging findings. In addition, the authors illustrate proper probe positioning, which is essential for visualizing the nerves at US. The authors' discussion focuses on the superficial and deep peroneal, sural, saphenous, tibial, medial and lateral plantar, medial and inferior calcaneal, common digital, and medial proper plantar digital nerves.
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Affiliation(s)
- Michel De Maeseneer
- From the Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium (M.D.M., M.S., J.D.M.); Department of Radiology, Royal Free Hospital, London Deanery, London, England (H.M.); Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (L.L.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (M.K.B.); Department of Radiology, Sint Andries Ziekenhuis Tielt, Tielt, Belgium (S.M.); and Department of Experimental Anatomy, Vrije Universiteit Brussel, Brussels, Belgium (A.S.)
| | - Hardi Madani
- From the Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium (M.D.M., M.S., J.D.M.); Department of Radiology, Royal Free Hospital, London Deanery, London, England (H.M.); Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (L.L.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (M.K.B.); Department of Radiology, Sint Andries Ziekenhuis Tielt, Tielt, Belgium (S.M.); and Department of Experimental Anatomy, Vrije Universiteit Brussel, Brussels, Belgium (A.S.)
| | - Leon Lenchik
- From the Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium (M.D.M., M.S., J.D.M.); Department of Radiology, Royal Free Hospital, London Deanery, London, England (H.M.); Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (L.L.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (M.K.B.); Department of Radiology, Sint Andries Ziekenhuis Tielt, Tielt, Belgium (S.M.); and Department of Experimental Anatomy, Vrije Universiteit Brussel, Brussels, Belgium (A.S.)
| | - Monica Kalume Brigido
- From the Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium (M.D.M., M.S., J.D.M.); Department of Radiology, Royal Free Hospital, London Deanery, London, England (H.M.); Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (L.L.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (M.K.B.); Department of Radiology, Sint Andries Ziekenhuis Tielt, Tielt, Belgium (S.M.); and Department of Experimental Anatomy, Vrije Universiteit Brussel, Brussels, Belgium (A.S.)
| | - Maryam Shahabpour
- From the Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium (M.D.M., M.S., J.D.M.); Department of Radiology, Royal Free Hospital, London Deanery, London, England (H.M.); Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (L.L.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (M.K.B.); Department of Radiology, Sint Andries Ziekenhuis Tielt, Tielt, Belgium (S.M.); and Department of Experimental Anatomy, Vrije Universiteit Brussel, Brussels, Belgium (A.S.)
| | - Stefaan Marcelis
- From the Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium (M.D.M., M.S., J.D.M.); Department of Radiology, Royal Free Hospital, London Deanery, London, England (H.M.); Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (L.L.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (M.K.B.); Department of Radiology, Sint Andries Ziekenhuis Tielt, Tielt, Belgium (S.M.); and Department of Experimental Anatomy, Vrije Universiteit Brussel, Brussels, Belgium (A.S.)
| | - Johan de Mey
- From the Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium (M.D.M., M.S., J.D.M.); Department of Radiology, Royal Free Hospital, London Deanery, London, England (H.M.); Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (L.L.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (M.K.B.); Department of Radiology, Sint Andries Ziekenhuis Tielt, Tielt, Belgium (S.M.); and Department of Experimental Anatomy, Vrije Universiteit Brussel, Brussels, Belgium (A.S.)
| | - Aldo Scafoglieri
- From the Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium (M.D.M., M.S., J.D.M.); Department of Radiology, Royal Free Hospital, London Deanery, London, England (H.M.); Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (L.L.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (M.K.B.); Department of Radiology, Sint Andries Ziekenhuis Tielt, Tielt, Belgium (S.M.); and Department of Experimental Anatomy, Vrije Universiteit Brussel, Brussels, Belgium (A.S.)
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